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Context Awareness in Health Care: a Review

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Context Awareness in Health Care: a Review i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 2–12 journal homepage: www.intl.elsevierhealth.com/journals/ijmi Review Context awareness in health care: A review a, b Nathalie Bricon-Souf ∗, Conrad R. Newman a Centre d’Etude et de Recherche en Informatique Medicale´ , Universite´ de Lille2, 59045 Lille, France b Centre for Health Informatics, University of New South Wales, Sydney, Australia a r t i c l e i n f o a b s t r a c t Article history: Background: Health care systems will integrate new computing paradigms in the coming Received 5 April 2005 years. Context-awareness computing is a research field which often refers to health care as Received in revised form an interesting and rich area of application. 4 January 2006 Aim: Through a survey of the research literature, we intended to derive an objective view Accepted 4 January 2006 of the actual dynamism of context awareness in health care, and to identify strengths and weaknesses in this field. Methods: After discussing definitions of context, we proposed a simple framework to analyse Keywords: and characterize the use of context through three main axes. We then focused on context- Context awareness awareness computing and reported on the main teams working in this area. We described Medical informatics some of the context-awareness projects in health care. A deeper analysis of the hospital- Health care based projects demonstrated the gap between recommendations expressed for modelling context awareness and the actual use in a prototype. Finally, we identified pitfalls encoun- tered in this area of research. Results: A number of opportunities remain for this evolving field of research. We found rel- atively few groups with such a specific focus. As yet there is no consensus as to the most appropriate models or attributes to include in context awareness. We conclude that a greater understanding of which aspects of context are important in a health care setting is required; the inherent sociotechnical nature of context-aware applications in health care; and the need to draw on a number of disciplines to conduct this research. © 2006 Elsevier Ireland Ltd. All rights reserved. Contents 1. Introduction . 3 1.1. Aim of the paper. 3 1.2. Methodology used for developing context-awareness analysis . 4 2. What is context?. 4 2.1. Definitions . 4 2.2. Analysis framework . 4 3. What is context-awareness computing? . 5 4. The “research context” of “context-awareness computing in health care”. 5 ∗ Corresponding author. Tel.: +33 3 20 62 68 29; fax: +33 3 20 62 68 81. E-mail address: [email protected] (N. Bricon-Souf). 1386-5056/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2006.01.003 i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 2–12 3 4.1. Main research teams and their projects . 5 4.2. Description of health care context-awareness projects . 5 4.2.1. Application . 5 4.2.2. Hospital-based prototypes . 7 4.2.3. Other prototypes . 7 4.2.4. Scenario . 7 5. What are the challenges? . 7 5.1. Actual characteristics of context-awareness application at the hospital . 7 5.2. Identified pitfalls with the use of context-awareness computing. 9 5.2.1. The system must remain intelligible . 9 5.2.2. People invent new conventions through new tools . 9 5.2.3. The purpose of the tool could be deviated . 9 6. Discussion . 9 7. Conclusion. 10 References . 10 1. Introduction In particular, current technologies allow the introduction of context awareness in every day activities. Health care will evolve as new technologies are adopted. Even Context awareness is a concept that has been described if it is difficult to predict what the future hospital will be, for some time, but technologies (e.g. wireless technologies, aspects such as context awareness will help health care pro- mobile tools, sensors, wearable instruments, intelligent arti- fessionals to shift part of their activities to machines. Rein- facts, handheld computers) are now available to support the vention of health care [1] is complex. In this paper, we aim to development of applications. Such technologies could help outline difficulties and possible solutions in the area of con- health care professionals to manage their tasks while increas- text awareness in health care. ing the quality of patient care. Nevertheless, new technolo- Even with the ongoing increase in hospitals use of com- gies impact the communication between agents. In his paper puterized tools (e.g. powerful hospital information systems, “Interaction design”, Coiera [16] presents a framework for the connected laboratory results) these tools are not sufficient design of interactions between human and computational and new technologies should support a new way of envis- agents working in organizations. He describes the impact of aging the future hospital. The future intelligent hospital will a new interaction class (in this discussion, a class that would be deeply different from the current one. The introduction of include context-awareness applications) within an organiza- future tools leads to challenging research problems [2–9]. First, tion. The introduction of a new interaction class will impact such an evolution requires new technologies and new archi- the level of interaction and communication by agents in terms tectures to implement secure and reliable systems. It requires of costs and benefits to individuals. When designing new inter- the identification and evaluation of what could be done, for action classes, one aim is to ensure optimization of benefit what purpose and how this could be implemented. It could versus cost to individuals. also induce new social or political problems in relation to pri- Health care systems could integrate context-awareness vacy concerns or acceptance of such systems. computing, not only to explore new tools but to propose useful Our focus is on identification, evaluation and implementa- and acceptable systems. tion of new tools or services for the communication and the Intensive care units (ICU’s) contain complex health care sit- cooperation of health care professionals. uations and are a challenging area for such systems. A number Communication between health care professionals repre- of researchers have underlined this context of work as par- sents a large part of their activity [10,11]. This communication, ticularly relevant to the evaluation of complex tools assisting direct or indirect, ranging from laboratory results to com- the cooperation between workers [17–19]. The medium term plex consultation and advice, is important and useful but at perspective of our research is the definition of a set of require- the same time induces many interruptions. This complicates ments for the use of context-awareness tools in the ICU. the cognitive activity of the health care providers. Cooper- Our preliminary work consists of the review of context ation of health care professionals is indispensable to care, awareness in health care, and is presented in this paper. but problems with transmission of information between them still induce breakdowns in communication [12,13]. Errors, 1.1. Aim of the paper which sometimes lead to the death of a patient, have been described in US hospitals [14], and obviously exist in all Through a survey of the existing literature in context- hospitals. awareness computing, we intend to discuss the most relevant Cooperation between health care professionals can be research relating to health care. increasingly mediated through computerized platforms (e.g. Section 2 presents a brief state of art on what is con- hospital-GP intermediation platforms, homecare coordination text, then proposes a framework for the analyses of the platforms, etc.). These coordination tools will integrate new context representation, in order to perform this review mobile tools and propose new communications abilities [15]. of the context-awareness projects in health care. Section 4 i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 2–12 3 briefly proposes a definition of context-awareness com- proposed by Dey matches this view. Another view can be sus- puting. Section 4 focuses on context-awareness comput- tained by phenomenological theory—context emerges from ing in health care: it presents some of the more rele- the activity and cannot be described independently. Some vant teams in this area, then describes the main health similar remarks are made by Winograd: “something is context care projects developed in such a topic. Section 5 presents because of the way it is used in interpretation” [23]. Faced with the challenges linked to such project: it analyses existing the complex notion of context, Sato proposes to represent con- research on hospital context awareness for health care and text through “a pattern of behavior or relations among vari- describes how closely such existing prototypes or applica- ables that are outside of the subjects of design manipulation tions match the above recommendations, then it mentions and potentially affect user behavior and system performance” the main pitfalls encountered in context-awareness comput- [24]. ing area. Section 6 gives a summary and a conclusion of this survey. 2.2. Analysis framework 1.2. Methodology used for developing.
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